No benefit of antibiotic treatment for hospitalised asthma patients
medwireNews: Findings from a large US study suggest that early treatment with antibiotics is not associated with improved outcomes among patients hospitalised for asthma exacerbation and treated with systemic corticosteroids.
In fact, patients treated with antibiotics had a longer length of hospital stay and higher hospital costs than those who were not, say Mihaela Stefan (University of Massachusetts, Springfield, USA) and study co-authors.
These results “lend strong support to current guidelines that recommend against the use of antibiotics in the absence of concomitant infection”, write the researchers in JAMA Internal Medicine.
Overall, the study included 19,811 patients without infection who were admitted to one of 542 acute care hospitals for asthma exacerbation in 2015–2016 and treated with oral or intravenous corticosteroids. A total of 44.4% of patients initiated antibiotic treatment during the first 2 days following hospital admission, most commonly macrolides (51.9%) and quinolones (34.8%).
After propensity score matching, the 6833 patients who received early antibiotic treatment had a significantly longer length of hospital stay than the same number of matched patients who were either not given antibiotics or started after the second day of hospitalisation, at a median of 4 versus 3 days.
The total cost of hospitalisation was also higher among patients who received early antibiotic treatment compared with those who did not (US$ 4776 vs 3641 [€ 4193 vs 3196]), as were rates of antibiotic-related diarrhoea (1.4 vs 1.1%).
However, there was no significant difference in rates of treatment failure – defined as initiation of mechanical ventilation, transfer to the intensive care unit after 2 days of hospitalisation, in-hospital mortality or readmission due to asthma exacerbation during the first 30 days after discharge – among patients who did and did not receive early antibiotic treatment, at 5.5% versus 5.7%.
Stefan and team note that their results “were consistent in multiple sensitivity analyses”, including an analysis restricted to nonsmoking patients aged younger than 70 years who did not have a primary diagnosis of acute respiratory failure and did not receive mechanical ventilation within 2 days of hospital admission, and an analysis that excluded patients treated with antibiotics after day 2 of hospitalisation.
These findings “reflect the experience of unselected patients cared for in routine settings” and “highlight the need for future research to improve antimicrobial stewardship in the setting of asthma”, conclude the researchers.
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